Payment by Results - Commissioning for outcomes

7/27/2019 Payment by Results - Commissioning for outcomes

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Payment by Results

Commissioning for outcomes

lessons learnt so far

Megan JonesSenior Programme ManagerAlcohol & Drugs Team


2/13

2010 Drug Strategy

2 PbR: commissioning issues


3/13

PbR will provide a constant and tough financial incentive forproviders to deliver good services (Open Public Services White

Paper July 2011)

where vulnerable users can't exercise choice for themselves, the

government should specify the result it is seeking, and then pay

the providers of the service if, but only if, they achieve that result

(Oliver Letwin, Guardian March 2012)

Putting an end to the process-fetishism of the past and savingtaxpayers billions (Oliver Letwin, Guardian March 2012)

PbR aims to transfer financial and operational risks away from the

commissioner, onto the provider, or funding bodies


Key theme of coalition government


4/13

Drug & Alcohol Recovery PbR Pilot


Dec 2010

Invitations

to

Participate

May 2015

Final Report

April 2011

March 2012

Co-design

April 2012

March 2014

ImplementationPilotActivity

IndependentEvaluation

Dec 2012

Interim Report

Sep 2013

Interim Report

Sep 2014

Interim Report

May 2013

First performancedata published


5/13

The Basic Model


Improved health

Free of drug(s)

Provider

1

Provider

3

Self referral

GP referral

LASARS

Assessment &

tariff-setting

Referral toprovider

Confirmation

of outcomes

to trigger

payments

Advocacy forclients

Provider

2

Sustained

recovery

Relapse & re-presentation

Prime provider/provider framework

Independent

service

CJ referral

Reduced offending


6/13


The Outcomes

Interim outcome Final outcome

OUTCOME DOMAINS

Free from drug(s) of

dependence

Health and

WellbeingReduced

Reoffending

Drug/alcohol usesignificantly improved

Abstinence

Successful completion

of treatment

Does not re-present in

either the treatment or

Criminal Justice

System for 12 months

Stops injecting

Housing situation

improves

Full course of Hepatitis

B vaccination

Achieves a normative

quality of life

COHORT

MEASURE

Reduction in the

number of provenoffences compared to

baseline


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Outcome Measures


Restricted to measures where a baseline exists to ensureeffective modelling

Treatment Outcome Profile (TOP) was a source of data,i.e self reporting

Offending measure: matches treatment data to policedata on proven offences

Some proxy measures used (e.g. non re-presentation for

sustained recovery)

Complexity groups measure the likelihood of achievingoutcomes


8/13

Lessons Learnt Culture change torecovery focus

PbR is time andresource-intensive: tariff-setting, contract

negotiations, data

analysis

Commissioners shareresponsibility: cannot let

services fail


CommissioningOpportunities

Performance managementwith financial teeth

Less day to day scrutiny -reduces commissioningoverheads

Providers take onresponsibility for outcomes


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Lessons Learnt

Contracts need to be flexible;consider TUPE; & cash-flow

issues for providers

Collaboration vs competition;providers can be risk-averse;

heavy admin burden

LASARS increase treatmentnumbers; service users like

LASARS.

9PbR: commissioning issues

CommissioningOpportunities

Change the market: goodproviders thrive, poor

ones exit

Diversify the marketcompetition, innovation,

value for money

LASARS single point ofcontact


10/13

Risks


Getting payments & weightings right: Individual vs cohort payments

Perverse incentives

Paying for dead weight Noise - random influences that affect outcomes

Cash-flow issues for providers

Gaming deliberate manipulation of thesystem for financial gain

Is there enough money in the system?


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Gaming

Specific risks:

Assessment of clients

Weighting and timing of payments for different PbRoutcomes

Misrepresenting or inflating success

Identifying and deterring:

Monitoring data Robust auditing and assessment of outcomes Involvement of service users in systematic, independent

assessment of their views and experiences



12/13

Financing


Is there enough money in the system?o Finite treatment budgets (PH Grant plus local

mainstream investment)

o Competitive tenders no new providers

Social Impact Bonds (SIB)o Social investment on basis of commitment from

govt. to pay for outcomes that result in savings to

public purse

o Majority of benefit accrues to central

government (CJ and employment benefit costs).


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PbR Useful Links

PbR DH Microsite link

http://recoverypbr.dh.gov.uk/

Lessons Learnt Link

http://recoverypbr.dh.gov.uk/2012/07/17/lessonslearnt/

PbR Performance Data Link

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/1

94007/Agenda_item_3.2_-_Pilot_data_for_publication_on_the_web.pdf

http://recoverypbr.dh.gov.uk/http://recoverypbr.dh.gov.uk/2012/07/17/lessonslearnt/https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/194007/Agenda_item_3.2_-_Pilot_data_for_publication_on_the_web.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/194007/Agenda_item_3.2_-_Pilot_data_for_publication_on_the_web.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/194007/Agenda_item_3.2_-_Pilot_data_for_publication_on_the_web.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/194007/Agenda_item_3.2_-_Pilot_data_for_publication_on_the_web.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/194007/Agenda_item_3.2_-_Pilot_data_for_publication_on_the_web.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/194007/Agenda_item_3.2_-_Pilot_data_for_publication_on_the_web.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/194007/Agenda_item_3.2_-_Pilot_data_for_publication_on_the_web.pdfhttp://recoverypbr.dh.gov.uk/2012/07/17/lessonslearnt/http://recoverypbr.dh.gov.uk/2012/07/17/lessonslearnt/http://recoverypbr.dh.gov.uk/2012/07/17/lessonslearnt/http://recoverypbr.dh.gov.uk/

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Payment by Results - Commissioning for outcomes